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DOI 10.17590/20201105-124936
Dry ice: carbon dioxide poisoning is possible
BfR Opinion No. 047/2020 issued 7 October 2020
Alongside its long-lasting cooling properties, which are utilised for the storage, ship-
ping and transportation of fresh and frozen goods, commercially available dry ice is
also used to create fog effects at events such as private parties or concerts. The Ger-
man Federal Institute for Risk Assessment (BfR) is publishing this Opinion on the
health risks of dry ice to consumers.
Cases of poisoning with dry ice occur worldwide, and have been reported in coun-
tries such as Germany, Japan, Thailand, Switzerland and the United States. Acci-
dents involving the handling of dry ice also include cases of frostbite or damage
caused by the explosion of freight containers. This BfR Opinion focuses on the risk of
poisoning.
The term ‘dry ice’ refers to solid carbon dioxide (CO 2) cooled to at least −78.5 °C. At
room temperature, dry ice turns into gaseous CO2 by sublimation. This is accompa-
nied by a strong increase in pressure with a risk of explosion in airtight containers.
The gaseous CO2 released by dry ice can cause suffocation. This is because the
CO2 displaces the oxygen in the air, such as in rooms with inadequate ventilation or
during transport in vehicles. As a result, the oxygen content of inhaled air is reduced.
At the same time, the uptake of oxygen into red blood cells is also reduced in the
lungs. High concentrations of CO2 in inhaled air can lead to an insufficient supply of
oxygen in the brain or bodily tissue. From simple headaches, symptoms at levels ex-
ceeding about 2 percent CO2 can include perspiration, shortness of breath, palpita-
tions, respiratory distress, fainting, visual disturbances, tremors and impaired con-
sciousness. At concentrations above 5 percent in inhaled air, CO2 has a narcotic ef-
fect. Once the level of CO2 exceeds about 8–10 percent, unconsciousness and death
by suffocation can occur in a matter of minutes.
The risk of dry ice poisoning increases in proportion to the quantity of dry ice used,
the size of the room and ventilation. As a general rule, dry ice should be stored and
transported only in appropriate, well-insulated containers. These containers must not
be airtight (danger of explosion). In enclosed spaces and vehicles, adequate ventila-
tion must always be ensured during transportation, storage and use.
© BfR, page 1 of 9German Federal Institute for Risk Assessment
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BfR risk profile:
Dry ice: carbon dioxide poisoning is possible
(Opinion no. 047/2020)
A Affected persons General population
Probability of an impair-
Practically
B ment to health from han- Unlikely Possible Likely Certain
impossible
dling dry ice
Severity of the impairment Severe
No Mild Moderate
C to health from handling impairment
impairment impairment impairment
dry ice (irreversible)
High:
Medium: Low:
The most important data are
D Validity of available data Some important data are A large volume of important data
available and are internally
missing or inconsistent is missing or inconsistent
consistent
Controllable with
Controllability by the con- Control not Controllable
E precautionary Not controllable
sumer [1] necessary by avoidance
measures
Fields with a dark blue background indicate the properties of the risk assessed in this opinion
(for more details, see the text of Opinion no. 047/2020 from the BfR dated 7 October 2020).
Explanations
The risk profile is intended to visualise the risk outlined in the BfR Opinion. The profile is not intended to be used to compare risks. The risk profile
should only be read in conjunction with the corresponding Opinion.
[1] – Row E – Controllability by the consumer
Details given in the row ‘Controllability by the consumer’ are merely descriptive and not to be understood as a recommendation by the BfR.
GERMAN FEDERAL INSTITUTE FOR RISK ASSESSMENT (BfR)
1 Subject of the assessment
The German Federal Institute for Risk Assessment (BfR) is issuing this Opinion on poisoning
in the context of the use of dry ice from the perspective of consumer health protection. Health
risks associated with the handling of dry ice include carbon dioxide poisoning, frostbite or dam-
age caused by the explosion of the packaging used to hold the dry ice. This BfR Opinion fo-
cuses on the risk of carbon dioxide poisoning that arises when consumers are involved in
handling dry ice.
A case involving at least three deaths and other casualties in connection with a birthday party
held in a Moscow steam sauna has been reported on recently in the media. At this event, 25
kg of dry ice was added to a pool containing warm water in order to create bubble and fog
effects. Carbon dioxide gas was rapidly released, leading to symptoms of suffocation and the
deaths of several guests.
A search of the published scientific literature and other publications available online revealed
only a few known cases of poisoning with dry ice for the period from 2013 to 2019.
In general, incidents involving (short-term) exposure to dry ice can be assigned to one of three
groups:
© BfR, page 2 of 9German Federal Institute for Risk Assessment
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(1) Acute poisoning by inhalation, including death resulting from suffocation by inhaling
very high concentrations of CO2 in inadequately ventilated spaces or motor vehi-
cles. Reports here include work-related accidents and accidents suffered by private
consumers.
(2) Frostbite (corrosive tissue damage) affecting the skin and mucous membranes of
the upper digestive tract, resulting from direct dermal or (more rarely) oral contact
with dry ice. Reports here include work-related accidents, accidents suffered by
private consumers and cases of misuse.
(3) Injuries suffered from fragments of bursting containers, resulting from the explosion
of gas-tight vessels used to hold dry ice (‘dry ice bombs’). Reports here include
work-related accidents, cases of misuse, accidents suffered by private consumers
and criminal activities.
Possible sources of danger
The use of dry ice can lead to cases of poisoning from carbon dioxide (CO2), since dry ice
sublimes to gaseous CO2. Known fatalities caused by CO2 typically result from an acute toxic
effect by inhalation in enclosed spaces. The BfR is not aware of any incidents of fatal injuries
caused by ‘dry ice bombs’ or frostbite caused by the chilling effects of dry ice.
Long-term (chronic) exposure to elevated concentrations of CO2 from the use of dry ice can
have effects on bone metabolism [1]; such effects include the accumulation of carbonate in the
bone matrix [2-4]. Potential risks to health caused by chronic exposure to elevated levels of
CO2 resulting from consumer use of dry ice are considered less relevant because of the as-
sumption that consumers do not handle dry ice on a daily basis.
The following potential sources of accidents when handling dry ice constitute the primary risks
for dry ice poisoning (after [5]):
1. Storage of large quantities
2. Storing and using dry ice in small, unventilated spaces
3. Transporting dry ice in passenger compartments
4. Storing dry ice in gas-tight containers (danger of explosion)
5. Failing to wear appropriate personal protective equipment
From reports in the press and research articles, it is clear that cases of poisoning involving dry
ice and carbon dioxide occur worldwide. Alongside Germany, cases have also been reported
in Japan, Thailand, Switzerland and the United States. For the USA, for example, the number
of fatalities caused by carbon dioxide poisoning (this figure also includes fatalities caused by
dry ice) is reported as a constant figure of roughly 90 cases (accidents at work) annually for
the period from the 1980s to 2015 [6].
© BfR, page 3 of 9German Federal Institute for Risk Assessment
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Table 1: Fatalities following the inhalation of elevated concentrations of CO2 in conjunction with the use
of dry ice. Results from open-access literature and an online search (illustrative, not representative).
Period No. of fatalities
2013 to 2019 5 deaths associated with dry ice in Germany [7-9]
2013 to 2019 4 deaths associated with dry ice (Switzerland, USA) [10-13]
2000 to 2011 21 deaths associated with CO2 (USA), with specific circumstances for each individual
case [14].
1994 to 2012 9 deaths associated with dry ice in other countries [5, 10, 15-20]
Reports of non-fatal cases of poisoning have also been published, as well as accidents in-
volving ‘dry ice bombs’ and cases of frostbite.
For the period 2013 to 2019, two cases were reported to the BfR concerning dry ice in ac-
cordance with section 16e of the German Chemicals Act:
• Case 1: 2017; professional use; 1 adult; dry ice vapours in an aircraft; mild symptoms: red-
dening of eyes, dry cough, retrosternal burning sensation, clinical examination was unre-
markable
• Case 2: 2018; professional use; 1 adult; transportation of dry ice in a car; mild symptoms:
dizziness, clinical and medical equipment based examination was unremarkable (incl. blood
gas analysis and X-ray examination of thorax)
In 2019, a request made to the German Poisons Information Service yielded 53 case reports
involving a total of 61 persons for the period from 2013 to 2019. In 31 of these 53 cases, the
usage was by private citizens. In these cases involving non-professional exposure, one fatal
case, one serious case and two moderately serious cases (but partly with mixed intoxication
(e.g. by party drugs) were documented. All other cases in the consumer segment involved
mild symptoms or an asymptomatic case history.
2 Hazard characterisation
Accidents involving dry ice can be harmful to health and can also be fatal in extreme cases.
The corresponding fatal cases have been caused by the sublimation of dry ice into gaseous
CO2 [5, 6, 10, 15, 21, 22]. Fatal incidents caused by dry ice must be viewed in the context of
the toxicity by inhalation of gaseous CO2.
The gaseous CO2 released by dry ice displaces oxygen and therefore decreases the partial
pressure of oxygen in inhaled air. In addition, CO2 acts as a respiratory poison or agent of
suffocation: As the concentration of gaseous CO2 in inhaled air rises, it becomes harder to
exhale the CO2 produced in the body via the lungs, while the uptake of oxygen into the red
blood cells is simultaneously reduced. As a result, an elevated level of CO2 in inhaled air results
in less oxygen being carried by red blood cells and can therefore cause suffocation even if the
partial pressure of oxygen in inhaled air is indeed adequate.
Depending on the concentration of CO2 in inhaled air and the duration of exposure, the con-
sequences of acute CO2 poisoning range from mild symptoms to a loss of consciousness or
even death (see also Table 3). At less than 2 percent, no acute symptoms of poisoning other
than a headache are to be expected. As the concentration of CO2 in air increases, CO2 levels
rise in the blood: a resulting respiratory acidosis then leads to an activation of the respiratory
centre, an increase in breathing frequency (tachypnea) and a rapid pulse. As CO2 levels in
© BfR, page 4 of 9German Federal Institute for Risk Assessment
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inhaled air continue to rise, symptoms such as dizziness, nausea, perceptual disorders, tinni-
tus, etc. are the first signs of a reduced oxygen supply the brain. At 5 percent, CO2 has a
narcotic effect and seizures or ECG changes can occur. From about 8–10 percent, CO2 causes
unconsciousness and can already be lethal. From about 20–30 percent, death can result in
just a few minutes.
The severity of symptoms depends on CO2 concentration and exposure time, while the indi-
vidual’s age and constitution will also determine the effects of CO2 on a case-by-case basis
[23]. These individual differences should be accounted for when assessing the poisoning risk
and in relation to drawing conclusions about the handling of dry ice. The recovery of one indi-
vidual after a severe case of CO2 poisoning involving the virtually complete saturation of room
air with CO2 has been reported (accident at work with liquid CO2 [21]). One should note, how-
ever, that the lack of oxygen can trigger the occurrence of brain damage that may prove to be
permanent.
For private consumers, temporary exposure to high concentrations of CO2 from ≥10 percent
by volume in inadequately ventilated spaces—such as vehicle interiors, basements or storage
areas—is considered to be a potential cause of death. For accident-related deaths, short ex-
posure times (of a few minutes) are presumed. An associated risk frequently arises in relation
to the incorrect handling of dry ice together with a lack of information about safety or proper
use. In the accident-related circumstances mentioned above, private consumers are at risk of
suffocation when handling dry ice.
Exposure
The two tables below present the known effects on health from elevated concentrations of CO2
in inhaled air as well as the standard values, guidance values and exposure limit values for
CO2 in inhaled air and in indoor air.
Table 2: Standard values, guidance values, exposure limit values and values for the acute toxicity of CO2
by inhalation. Dose-dependent and time-based effects of elevated CO2 concentrations in humans.
Standard values, guidance values and exposure limit values for CO2
CO2 conc. in Exposure Effect/result
inhaled air time
[% vol.]
0.04 --- • Standard value for inhaled air [6, 7]
0.1 --- • Upper limit value for indoor air, accounts for elevated CO2 concentra-
tion with simultaneous lower/decreasing concentration of O2 in indoor
air [4]
0.14 --- • Value used to classify indoor air as having a low air quality (DIN 2007-
09) [1]
0.5 8 h twa • Maximal admissible concentration (MAK value), does not apply to arti-
ficially ventilated rooms [4]
twa = time-weighted average, MAK = maximal admissible concentration
© BfR, page 5 of 9German Federal Institute for Risk Assessment
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Table 3: Dose-dependent and duration-related effects of elevated CO2 concentrations in humans.
Dose-dependent and duration-related effects of elevated CO2 concentrations in humans
CO2 conc. in Exposure Effect/result
inhaled air time
[% vol.]
≥0.1 n.d. • Tension in head, headache [2]
≤2 n.d. • No effects [10]
2.5 n.d. • Impairments to perception [1]
2–6 n.d. • Tachypnea[10]
≥3 n.d. • Hypercapnia/respiratory acidosis [2, 3], resp. distress [2]
3–5 n.d. • Stimulates the respiratory centre via chemoreceptors [2, 3]
4–7 (approx.) n.d. • Stimulus of respiratory centre, elevated pulse, disturbed blood circula-
tion in the brain, giddiness, nausea, buzzing in the ears [24]
>5 n.d. • Narcosis [2, 3]
6 6–8 min • Changes in ECG (older persons (aged approx. 60) more affected than
younger individuals (aged 23)) [4]
8–10 (approx.) n.d. • Symptoms worsen at approx. 4–7 % vol. (see above), convulsions, un-
consciousness with death following soon after [24]
10 n.d. • Unconsciousness [23]
• Potentially fatal [23]
• Weakness, tinnitus, increased sensitivity to pain [2]
>10 n.d. • Headache, sweating
• Fatal consequences [3]
• Rapidly leads to death [24]
10–20 min • Loss of consciousness [4]
10–30 n.d. • Weakening of visual perception, sensitivity to light, nystagmus, weak-
ening of auditory perception, vomiting [10]
>17 20–52 sec • Unconsciousness, dizziness, blurred vision, irritation to the throat [4]
>20 1 min • Unconsciousness, convulsions [4]
≥20 A few • Death is likely [10]
minutes
25 n.d. • Palpitations, convulsions [2]
≥30 Immediate • Unconsciousness and rapid death [10]
Continuous and Several • Declined blood levels of calcium and inorganic phosphate [4]
permanent ex- days • Accumulation of carbonate in bone tissue/matrix [2-4].
posure to ele-
vated levels of
CO2
0.7 to 1.2 26 days • Significant drop in performance when testing visual motor skills [22]
n.d. = no data
3 The legal situation
German occupational safety legislation defines an occupational exposure limit of 5000 ml/m3
(ppm) or 9100 mg/m 3 (TRGS 900 [25]). This is equivalent to a permitted concentration of CO2
in the workplace of 0.5 percent. This concentration is roughly 12.5x the level of CO2 found in
normal inhaled air (0.04%).
The European Agreement Concerning the International Carriage of Dangerous Goods by Road
(ADR) contains provisions that specify regulations for the classification, packaging, labelling
and documentation of dangerous goods, for their handling during this conveyance and for the
vehicles used to carry these goods. For dry ice (UN1845), the special provisions in ADR 5.5.3
are to be applied [26]. These provisions include requirements for instructing the employees
involved, for the consignments (packaging, labelling), and for the documentation and vehicle
markings. Since 2017, an identification requirement has also applied to all types of conveyance
utilised for dry ice in road traffic, regardless of whether this material is carried as a coolant or
© BfR, page 6 of 9German Federal Institute for Risk Assessment
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conditioning agent or as a consignment (to be labelled as ‘CARBON DIOXIDE, SOLID’, possi-
bly with the suffix ‘AS COOLANT’). Alongside this requirement to label individual shipments, a
special warning notice must also be affixed to vehicles and containers without adequate ven-
tilation.
Since 1 January 1999, private citizens have been exempt from dangerous goods legislation
applying to road traffic. Accordingly, private citizens may convey dangerous goods if these are
“packaged as appropriate for retail sale, and are intended for personal or household use, or
for sport and leisure activities”.
Carbon dioxide is listed in Annex IV of Regulation (EU) No 1907/2006 (REACH). In accordance
with point (a) of Article 2(7) of the REACH Regulation, substances listed in Annex IV are ex-
empted from Titles II (registration), V (downstream users) and VI (evaluation), “as sufficient
information is known about these substances that they are considered to cause minimum risk
because of their intrinsic properties”.
The acute toxicity of dry ice or CO2 is low in comparison with many other substances. Accord-
ing to Regulation (EU) No 1272/2008 (CLP), carbon dioxide is not classified as acute toxic,
and shall only be labelled when it is marketed as a pressurised gas.
4 Risk characterisation
Cases of poisoning from the CO2 released by dry ice occur both in a professional and private
context. Cases of severe or fatal poisonings are rare, however. The cases described in the
literature occurred due to incorrect storage, transportation or use, or are the result of suicidal
intent.
Related risks frequently arise in relation to the incorrect handling of dry ice together with a lack
of information about safety or proper use. In the accident-related circumstances as described,
a general risk of suffocation when handling dry ice is present for private consumers.
The specific risk of suffocation from the release of gaseous carbon dioxide by sublimation from
dry ice can be defined on a case-by-case basis. To obtain a quantitative estimate of the risk,
a number of factors must be considered:
• Quantity of dry ice: the larger the quantity, the larger the volume of CO2 that can be re-
leased
• Size of room, ventilation: the smaller and less well-ventilated the room (e.g. bathroom,
vehicle (and space taken up by cargo in vehicle)), the greater the concentration of CO2 in
the air
• Sublimation rate: high temperatures and good heat dissipation increase the rate of subli-
mation, resulting in the faster release of CO2—e.g. as a result of direct contact with warm
water (fog effects in swimming pool)
• Conditions of the room, as well as individuals’ physical size and posture: since CO2 is
heavier than air, CO2 concentrations are higher near to the ground (basement, swimming
pool, sitting/lying on the ground)
• Activity and number of individuals, initial concentration of CO2 in the room
• Packaging: type, gas permeability, insulation
Accordingly, consumers should only use dry ice in smaller quantities—such as for the cooling
of perishable goods, for example. Adequate ventilation of the storage facility and/or means of
© BfR, page 7 of 9German Federal Institute for Risk Assessment
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transport (passenger vehicle) should be ensured, as well as good heat insulation, gas perme-
ability for the freight container (danger of explosion) and insulated gloves/clothing while han-
dling.
Further information on the subject of poisoning from the BfR website:
https://www.bfr.bund.de/en/poisonings-10142.html
BfR ‘Opinions app’
5 References
1. UBA, Gesundheitliche Bewertung von Kohlendioxid in der Innenraumluft.
Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz, 2008. 51(11):
p. 1358-1369.
2. Kurzweil, P., Toxikologie und Gefahrstoffe - Gifte - Wirkungen - Arbeitssicherheit. 1.
Auflage ed. 2013: Europa Lehrmittel.
3. Reichl, F.-X., Taschenatlas der Toxikologie. 3. Auflage ed. 2009: Thieme Verlag
4. MAK, Kohlendioxid [MAK Value Documentation in German language, 2002], in The
MAK‐Collection for Occupational Health and Safety. 2002. p. 1-1.
5. Giesecke, J., et al., Death by dry ice. Rechtsmedizin, 2017. 27(6): p. 536-541.
6. Permentier, K., et al., Carbon dioxide poisoning: A literature review of an often
forgotten cause of intoxication in the emergency department. International Journal of
Emergency Medicine, 2017. 10(1): p. 14.
7. Bundschuh, M. and A. Gerber, Trockeneis: Ein aktuelles Unfallgeschehen aufgrund
unsachgemäßen Umgangs mit CO2. Zentralblatt für Arbeitsmedizin, Arbeitsschutz
und Ergonomie, 2013. 63(6): p. 348-349.
8. Bucher, G. Der mysteriöse Trockeneis-Tod des Star-Gastronoms. Welt, 2013.
https://www.welt.de/vermischtes/prominente/article117839645/Der-mysterioese-
Trockeneis-Tod-des-Star-Gastronoms.html.
9. Kettner, M., et al., A fatal case of CO(2) intoxication in a fermentation tank. Journal of
Forensic Sciences, 2013. 58(2): p. 556-558.
10. La Harpe, R., et al., Fatality in a wine vat. The American Journal of Forensic Medicine
and Pathology, 2013. 34(2): p. 119-121.
11. Rupp, W.R., et al., Suicide by carbon dioxide. Forensic Science International, 2013.
231(1-3): p. e30-e32.
12. Nedelman, M. Ice cream salesman's wife and mother suffocated by dry ice in car.
2018. https://edition.cnn.com/2018/08/01/health/dry-ice-death/index.html.
13. U.S.News Man delivering dry ice to McDonald's dies in chemical leak. 2018.
https://www.usnews.com/news/best-states/minnesota/articles/2018-11-21/man-
delivering-dry-ice-to-mcdonalds-dies-in-chemical-leak.
14. Punja, M., Carbon dioxide associated poisoning fatalities in the USA from 2000 to
2011. Journal of Medical Toxicology, 2014. 10(1): p. 90.
15. Srisont, S., T. Chirachariyavej, and A.V. Peonim, A carbon dioxide fatality from dry
ice. Journal of Forensic Sciences, 2009. 54(4): p. 961-962.
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16. Downs, J.C., S.E. Conradi, and C.A. Nichols, Suicide by environmental hypoxia
(forced depletion of oxygen). The American Journal of Forensic Medicine and
Pathology, 1994. 15(3): p. 216-223.
17. Dunford, J.V., et al., Asphyxiation due to dry ice in a walk-in freezer. Journal of
Emergency Medicine, 2009. 36(4): p. 353-356.
18. Gill, J.R., S.F. Ely, and Z. Hua, Environmental gas displacement: Three accidental
deaths in the workplace. The American Journal of Forensic Medicine and Pathology,
2002. 23(1): p. 26-30.
19. Norimine, E., et al., Suicide case of carbon dioxide poisoning using dry ice. The
Japanese Journal of Toxicology, 2009. 22(2): p. 121-124.
20. Khokhlov, V.D., [A case of fatal carbon dioxide gas poisoning]. [Sudebno-
meditsinskaia ekspertiza], 1996. 39(2): p. 47-48.
21. Halpern, P., et al., Exposure to extremely high concentrations of carbon dioxide: A
clinical description of a mass casualty incident. Annals of Emergency Medicine, 2004.
43(2): p. 196-199.
22. Manzey, D. and B. Lorenz, Joint NASA-ESA-DARA Study. Part three: effects of
chronically elevated CO2 on mental performance during 26 days of confinement.
Aviation, Space, and Environmental Medicine, 1998. 69(5): p. 506-514.
23. OSHA Potential carbon dioxide (CO2) asphyxiation hazard when filling stationary low
pressure CO2 supply systems. OSHA Hazard Information Bulletins, 1996.
https://www.osha.gov/dts/hib/hib_data/hib19960605.html.
24. LMU, Verwendung von Trockeneis als Kühlmittel – UN1845, L.-M.-U. München,
Editor. 2018, Stabsstelle AuN: Munich, Germany. p. 1-5.
25. Bundesanstalt für Arbeitsschutz und Arbeitsmedizin TRGS 900
Arbeitsplatzgrenzwerte. Technische Regel für Gefahrstoffe, 2020.
https://www.baua.de/DE/Angebote/Rechtstexte-und-Technische-
Regeln/Regelwerk/TRGS/TRGS-900.html.
26. Bundesministerium für Verkehr und digitale Infrastruktur Anlage zur Bekanntmachung
der Neufassung der Anlagen A und B des Europäischen Übereinkommens vom 30.
September 1957 über die internationale Beförderung gefährlicher Güter auf der
Straße (ADR). 2019.
www.bgbl.de/xaver/bgbl/start.xav?startbk=Bundesanzeiger_BGBl&jumpTo=bgbl2190
14_Anlageband.pdf.
About the BfR
The German Federal Institute for Risk Assessment (BfR) is a scientifically independent insti-
tution within the portfolio of the Federal Ministry of Food and Agriculture (BMEL) in Germany.
It advises the German federal government and German federal states (“Laender”) on ques-
tions of food, chemical and product safety. The BfR conducts its own research on topics that
are closely linked to its assessment tasks.
This text version is a translation of the original German text which is the only legally binding
version.
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